Treatment for Foot Pain

The newest and best treatments for everything from calluses to heel pain.

Your poor feet. Not only do they travel tens of thousands of miles throughout your life, carrying the weight of your body all the way, but they often must do so in shoes that squeeze and bend them into positions they were never meant to take. No wonder they hurt. But you don't have to put up with the pain. In fact, you shouldn't: The sooner you deal with a foot problem, the less likely it'll lead to other complications. And with new treatments for many common disorders, you have no reason to hobble — or to give up stylish heels.

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The big bump: bunion

What it is: A knob at the base of the big toe. Blame ill-fitting shoes that push the big toe inward, so that the joint sticks out sideways; the area around the joint becomes swollen and sore, and over time, extra bone forms in that spot, pushing the toe over even farther. (Tight shoes are not the only culprits:?In some cases, lax ligaments cause the toe to drift into this position.)

Try this first: To reduce pressure on the joint, switch to low-heeled shoes that are wide across the toes and ball of your foot. (You may want to have your favorite shoes professionally stretched.) A toe spacer — a small cushion placed between the first and second toes — helps keep bones straight so that the bunion won't get worse.

A doctor's help: A physical therapist can use ultrasound and massage to calm inflammation in the tissue around the bunion. As for custom-fitted prescription shoe inserts (orthotics), the jury is still out: Some experts believe the inserts correct muscle imbalances and gait problems that contribute to bunions. But others, saying the benefits haven't been proven, question whether orthotics are worth the $300 or so they may cost.

Surgery? Only as a last resort. Bunionectomy, which involves not only shaving off the existing bump but also breaking and repositioning the bone of the big toe to prevent a recurrence, is hardly a walk in the park. And you may have trouble walking at all if complications arise. "When you change the mechanics of the big toe, you run the risk of affecting other parts of the foot and its function," says Rock Positano, D.P.M., director of the Non-operative Foot and Ankle Center at the Hospital for Special Surgery in New York City. Potential problems range from pain in other toes to arthritis and even nerve damage. If you do opt for surgery, make sure your doctor refers you to a physical therapist so you can learn simple exercises to restore range of motion in the toe.

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Bitty bumps: corns and calluses

What they are Calluses are hardened layers of skin that build up in response to friction, such as rubbing against a seam in your shoe. A callus on the top or end of a toe is known as a corn. Tight shoes are often the culprit, but so are loose ones — your foot may rub as it slides around inside the shoe.

Try this first: Place a donut-shaped pad over a corn or lambswool between your toes to relieve pressure. You can soak your foot in warm water for five to ten minutes to soften skin, then file the spot gently with a pumice stone, but don't get carried away — removing too much skin invites infection. An over-the-counter product containing salicylic acid exfoliates dead skin but won't remove the hard spot completely, and it may irritate skin.

A doctor's help: See a podiatrist if at-home care doesn't relieve pain. And if you're diabetic or have poor circulation, don't let anyone but a doctor near your corns.

Foul ball: neuroma

What it is: Buildup of nerve tissue in the ball of your foot, often caused by wearing narrow shoes that push the bones together, irritating nearby nerves. The area may burn (you may feel like you're stepping on a pebble), and you may also have tingling or numbness in your toes.

Try this first: Wider, lower-heeled shoes relieve pain; you can also place a shoe pad slightly behind the sore spot to spread out the bones in your foot and elevate the nerve.

A doctor's help: Specialists may inject cortisone to reduce inflammation, but the effect is usually temporary. Also, there can be complications, including weakness in nearby ligaments and — if the needle hits the nerve directly — trauma, leading to persistent pain. Some doctors claim they get better results by using a sonogram to locate the precise spot for injection.

Surgery? Not a good idea, most experts say. Patients can develop "stump neuroma," in which the remaining tissue becomes hypersensitive — and still hurts.

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On poor footing: plantar fasciitis

What it is: A microscopic tear in the tissue (called the plantar fascia) that runs along the sole of the foot from the heel to the base of the toes. The bottom of your heel hurts, especially first thing in the morning. Causes include walking on hard surfaces, exercising more than usual, being overweight, or wearing extremely soft, slipper-like shoes that don't give you enough support. Although an X ray might reveal a spur — a bit of bone protruding from the heel — experts believe that it's not the spur that causes the pain, but actually nearby tissue.

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Try this first: A gentle stretch: Before you take your first step out of bed, sit up and cross one leg over the other so the ankle of the sore foot rests on your other knee. With one hand, pull toes back toward your shin until your arch feels tight — "like a guitar string," says Benedict DiGiovanni, M.D., an orthopedist at the University of Rochester School of Medicine. Hold for ten counts, then release and repeat three more times. Do this several more times during the course of the day, especially after you've been sitting for a while, when the tissue is most vulnerable to injury. Most patients find that the pain is greatly reduced within eight weeks, reports Dr. DiGiovanni. Shoe inserts cushion the area while it's healing (University of Rochester researchers used Spenco cross-trainers in their studies).

Surgery? Few experts recommend having the spur removed; the operation can lead to scarring and even worse inflammation.

The other heel pain: "pump bump"

What it is: An inflammation of the spot where the heel meets the Achilles tendon; you'll feel a pump bump (and see it) on the back of your heel. Most common cause: wearing shoes that press or rub at the back of your foot or against your heel.

Try this first: Pain can usually be relieved by padding the swollen spot or placing a fairly thick pad under the heel so the sore spot is higher than your shoe back. Choose open-back shoes (or slingbacks if they don't rub on the bump). Gently stretching the Achilles tendon a few times a day helps too: Lean against a wall with one leg forward and bent at the knee, the other leg straight behind you, both feet flat on the floor with your toes toward the wall. Feel your rear calf stretch as you lean forward. Hold for ten seconds, relax, and repeat five times.

Bent out of shape: hammertoe

What it is: Short- or narrow-toed shoes can turn you into Cinderella's stepsister, with your toes scrunched so the middle joints stick up like an upside-down V. After years of such mistreatment, they may become locked in that position. "Remember how your mom told you not to make an ugly face because it might stay that way? Well, your toes really will stay that way," says Steven L. Haddad, M.D., assistant professor of clinical orthopedic surgery at Northwestern University.

Prevention: If you must wear narrow-toed shoes, be sure to stretch your toes that evening: Grasp the middle joint and gently pull your toe straight out or even slightly upward for ten seconds (don't pop the knuckle). Repeat 20 times, stretching all ten toes.

A doctor's help: If you notice a hammertoe developing, see a foot specialist right away. Your doctor may show you how to tape the toe in place to reverse the problem.

Surgery? You can have the hammertoe straightened, but because the operation involves removing the raised knuckle, you won't be able to bend your toe afterward. "It will be straight and stiff instead of bent and stiff," explains Dr. Haddad. Most people can get by without surgery if they wear shoes that have extra-deep toe boxes, he adds. And sliding a gel-filled sleeve over the bent toe will minimize chafing.

Warts and all: plantar warts

What they are A viral growth on the plantar, or bottom, surface of the foot. It may go away by itself, but that can take a few years, and walking may be painful. Never pick at the wart, says Tracey Vlahovic, D.P.M., an instructor at the Temple University School of Podiatric Medicine. It may react to the trauma by getting bigger.

Prevention: The virus is highly contagious and loves moisture, so wear flip-flops around swimming pools or in health-club locker rooms, advises Dr. Vlahovic.

A doctor's help: Your specialist may try a high-potency peeling solution or liquid nitrogen (though that can be painful and is usually less effective than peels). Best, says Dr. Vlahovic, is a pulsed-dye laser, which is less likely to leave scars than old-fashioned surgical cutting. You may also be advised to use an over-the-counter product (these wart removers aren't strong enough to work on their own for plantar warts).